Impact of intraoperative goal-directed therapy on perioperative outcomes in kidney transplantation: a multicenter randomized controlled trial

Appropriate fluid management is crucial in anesthesiologic management during kidney transplantation (KT). Traditional parameters such as blood pressure and central venous pressure are unreliable and weakly supported by guidelines. Goal-directed fluid therapy (GDT) has emerged as a technique for administering fluids and vasoactive drugs based on algorithms to ensure adequate tissue perfusion. Current data suggest GDT may reduce tissue edema and respiratory complications in KT recipients. This multicenter, single-blind randomized controlled trial compared conventional fluid management strategies with a GDT algorithm using non-invasive pulse pressure contour analysis monitoring (ClearSight®) in KT patients. The primary outcome was the hospital length of stay. Secondary outcomes included postoperative complications, delayed graft function, 90-day graft loss, and intensive care unit (ICU) length of stay. Patients and postoperative care physicians were blinded to group assignments. The study enrolled 181 KT recipients over 32 months. The hospital length of stay did not significantly differ between the groups, with a difference of 0.5 days (95% CI: -2.5 to 5 days). No significant differences were found in surgical and medical complications, delayed graft function, graft loss, or ICU length of stay. In KT recipients, using a GDT algorithm did not result in clinically meaningful differences in hospital stay, complications, or graft dysfunction/loss.